Goldberg J F, Singer T M, Garno J L
Bipolar Disorders Research Clinic, Payne Whitney Clinic-New York Presbyterian Hospital, New York 10021, USA.
J Clin Psychiatry. 2001;62 Suppl 25:35-43.
The relationship between suicidality and substance abuse has long been recognized, although studies have only fairly recently begun to identify factors that may help clarify how alcohol or other drug abuse increases the susceptibility to suicidal behavior in vulnerable populations. In particular, alcohol and other psychoactive substance misuse has been linked with mood destabilization and the induction of manic or depressive episodes in affectively ill individuals, while also demarcating groups with heightened tendencies toward impulsivity, aggression, and sensitivity to interpersonal loss. Serotonergic mechanisms have been implicated in each of these clinical settings, along with possible dysregulation of other neurotransmitter systems. Psychosocial aspects of alcohol or drug abuse relevant to suicide may involve a heightened sensitivity to interpersonal loss, poor coping skills in response to adverse life events, and affective dysregulation induced by circadian and psychosocial stresses. Consequently, self-destructive behaviors with relatively little premeditation may arise during periods of increased stress, intoxication, depression, or other psychopathology. Early detection of substance abuse followed by appropriate pharmacologic and/or psychotherapeutic interventions may greatly help to minimize the formation of complex comorbid psychiatric conditions and reduce the potential for suicidal acts among high-risk populations.
自杀倾向与药物滥用之间的关系早已为人所知，尽管直到最近研究才开始确定一些因素，这些因素可能有助于阐明酒精或其他药物滥用是如何增加易感人群自杀行为易感性的。特别是，酒精和其他精神活性物质的滥用与情绪不稳定以及情感障碍患者躁狂或抑郁发作的诱发有关，同时也区分出了具有较高冲动性、攻击性和对人际丧失敏感性倾向的群体。血清素能机制在这些临床情况中均有涉及，其他神经递质系统也可能存在失调。与自杀相关的酒精或药物滥用的心理社会方面可能包括对人际丧失的高度敏感、应对不良生活事件的能力差以及昼夜节律和心理社会压力引起的情感失调。因此，在压力增加、中毒、抑郁或其他精神病理状态期间，可能会出现较少预谋的自我毁灭行为。早期发现药物滥用并随后进行适当的药物和/或心理治疗干预，可能极大地有助于减少复杂共病精神疾病的形成，并降低高危人群自杀行为的可能性。
